How does Alzheimer’s and other dementias affect driving in older adults?


March 31, 2022

Drivers with Alzheimer’s and other dementias are at a high risk of unsafe driving.

Memory loss alone does not impair the critical cognitive processes needed for safe driving, but it could impact the ability of a driver to navigate without getting lost and may increase safety risk under challenging circumstances. However, studies have shown that drivers with dementia have an approximately two to five times greater risk of involvement in a crash compared with age-matched control groups. The risk of crashing for a driver who has had Alzheimer’s disease for more than three years is higher even than teenage male drivers. 

Most research and public policy directives dealing with drivers with dementia have focused on defining methods to detect unsafe drivers and removing them from the active driving pool. There is a broad consensus that moderately severe dementia precludes safe driving; however, there is still no consensus on how to deal with those with questionable or mild dementia who are minimally or only mildly dependent on others for assistance with their other daily living activities.

Driving is a complex activity that always becomes impaired at some point in older adults with degenerative dementia.

Over time, disruption of the visual processing circuits of the brain that link the occipital and prefrontal regions, particularly in the right hemisphere, leads to increasing degrees of driving impairment that ultimately preclude safe driving. Neuropsychological tests of visuospatial ability, executive function and attention that tap into the integrity of these brain regions provide the clinician with important information regarding the need for a formal determination of driving competence. Enhancement of cognitive function in these domains through anti-dementia therapy and exercise may partially mitigate risk; however, all drivers with dementia must ultimately retire from driving when dementia becomes moderately severe, and often in earlier stages of the illness. Future efforts to improve screening tests for hazardous driving and to develop interventions to help prolong the time that drivers with mild dementia can continue to drive safely are needed for our increasingly aged and mobile population.

Cognitive impairment is not uncommon in older drivers.

In one community-based study of 3238 drivers aged 65 years and older, applying for a renewal of their North Carolina driver’s license, who were examined using the Short Blessed Mental Status Examination, the following age groups were moderately or severely impaired: 

  • 6.2% of those aged between 65 and 69 years
  • 7.7% of those aged between 70 and 74 years
  • 11.9% of those aged between 75 and 79 years
  • 18.7% of those aged 80 years or above 

In conclusion, a diagnosis of early Alzheimer’s disease or dementia does not necessarily preclude safe driving, but it is always a risk factor. Consult your medical advisors for information specific to your situation. 

Source: Dr. Biran R. Ott & Dr. Lori A Daiello, Department of Neurology, Brown University; National Library of Medicine:

We hope this information is helpful to you in the important work you do as a family caregiver.
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